Dépistage et prévention chez les aînés: quelles interventions proposer, à qui, et jusqu'à quel âge [Screening and prevention in the elderly: which interventions should be proposed, to whom, and up to what age?].

Recommendations on preventive services rarely mention how to apply them to older people. Even though general criteria (prevalence of disease, quality of screening tests) that influence screening's efficacy remain important, appropriateness of screening in older persons depends much more on individual criteria, such as comorbidity, functional status, and life expectancy. More than with any other age group, patients preferences regarding future investigation and treatment guide the clinical decision. This article focuses on primary and secondary prevention, and discusses specific criteria to consider in each patient. A table summarizes the appropriate recommendations.

Acute total hip arthroplasty for acetabular fractures in the elderly: 11 patients followed for 2 years.

We describe the use of cable fixation and acute total hip replacement for acetabular fracture in the elderly. 12 patients with acetabular fractures, having a mean age of 79 (65-93) years, were treated with cable fixation and acute total hip arthroplasty. 8 were T-shaped fractures and 4 associated fractures of the posterior column and posterior wall. 1 patient died 5 months after surgery and the remaining 11 were followed for 2 years. All patients had a good clinical outcome. Radiographic assessment showed healing of the fracture and a satisfactory alignment of the cup without loosening. This surgical technique provides good primary fixation, stabilizes complex acetabular fractures in elderly patients with osteoporotic bone and permits early postoperative mobilization.

Aptitude à la conduite, pathologies psychiatriques et psychotropes chez la personne âgée [Driving ability, mental illness and psychotropic medication in the elderly].

Fitness to drive in elderly drivers is most commonly discussed with a focus on cognitive impairment. Therefore, this article is focussing on mental illness and the use of psychotropic drugs in elderly drivers, which can both interfere with fitness to drive. Based on a detailed literature review and on clinical judgement, we propose signposts and "red flags" to judge the individual risks. Health professionals dealing with elderly patients should in particular be aware of the dangers related to cumulative risks and need to inform the patients appropriately. For medico-legal reasons the information provided to patients must be written down in the medical record. Individual counselling is important as fitness to drive is a complex topic.

Evaluation de la sarcopénie de la personne agée par la bio-impédance spectroscopique [Multispectral bioimpedance and sarcopenia in the elderly].

The definition of sarcopenia includes both a loss of muscle strength and a decline in functional quality in addition to the loss of muscle protein mass. Multispectral bioimpendance allows bedside assessment of muscle mass. Using this new tool, we performed a pilot study to look for a possible correlation between muscle mass and various tests of muscle strength (grip strength, key-pitch, tip-pinch) and with functional tests (walk speed on 10 meters and Tinetti test). Our study demonstrates a good correlation between muscle mass determined by spectroscopic bioimpendance and muscle strength assessment, but no correlation with functional tests.

De l'enquête à l'offre de soutien des parents endeuillés

Cet article présente la réflexion et l'élaboration d'un programme de soutien auprès de parents d'enfants décédés ainsi que de sa mise en application. L'enquête auprès des parents endeuillés a été conduite sous forme d'entretiens semi-dirigés. L'enquête auprès des professionnels a été réalisée en deux temps. Tout d'abord par le biais d'un questionnaire qui par la suite a été complété par des focus groupes pluridisciplinaires. Un programme de soutien aux parents endeuillés a été élaboré qui est une démarche complémentaire et ne remplace pas les accompagnements individuels ou de couple par des professionnels du deuil, des psychologues ou des groupes de soutien. Ce programme de soutien est conçu en faveur d'une relation humaine de la part de l'institution médicale et hospitalière. Il est là pour éviter de mettre au rang de l'oubli, de l'isolement un vécu commun de souffrance et d'enrichissement et de prendre le risque de laisser les endeuillés comme les professionnels dans des non-dits et des sentiments d'incompréhension face à la mort de l'enfant

Evaluation préopératoire des patients ages [Preoperative assessment in elderly patients].

Age-related physiological changes and comorbidities affect older patients' tolerance to surgery. Pre-operative assessment in these patients requires, beside the usual physical evaluation, the systematic screening of common geriatric syndromes. Cognitive, gait and balance, nutritional, and functional impairments, all flag patients at higher risk for per- and postoperative complications. Preoperative assessment is an opportunity to detect these syndromes and propose preventative interventions (physical therapy, nutritional and cognitive support measures) likely to reduce the incidence of postoperative morbidity.

Young infants' triangular communication with their parents in the context of maternal postpartum psychosis: Four case studies

With increasing data on the dynamics of normative couples as they transition to parenthood and become a triad, the need for greater understanding of the impact of parental psychopathology on this transition has become clear. The goal of the current article is to begin exploring this area that has received little attention to date, by describing case examples from a study of clinical families as they transitioned to parenthood. Four representative cases were selected from a pool of 13 mother-father-baby triads, for whom the mother had been hospitalized conjointly with her infant due to a psychotic episode during the postpartum period. The families were observed as part of a clinical consultation that included a semistructured play paradigm known as the Lausanne Trilogue Play (LTP; E. Fivaz-Depeursinge, & A. Corboz-Warnery, 1999). Interactions were scored using standardized measures as well as clinical impressions. All families from the clinical sample were noted to struggle and frequently failed to achieve the goals of play. The impact on the infants in terms of their developing sense of self as well as their defensive strategies in this context are discussed, with clinical implications explored.

Validation française d'un questionnaire de stress post-traumatique destiné aux parents d'enfants présentant un risque périnatal élevé = French validation of the "Perinatal PTSD Questionnaire" assessing parent's posttraumatic stress reactions following the birth of a high risk infant.

(from the journal abstract) Objectives: The birth of a high risk infant--such as a very or extremely premature infant--can represent an important traumatic experience for parents. R. DeMier, M. Hynan et al's "Perinatal PTSD Questionnaire" aims at exploring, retrospectively, parent's posttraumatic stress reactions following the birth of a high risk infant. This paper describes the French validation of this questionnaire. Methods: Fifty-two families with a very or extremely premature infant and 25 families with a full term infant responded to the "Perinatal PTSD Questionnaire" and the "Impact of Event Scale" when children were 18 months old. Results: Parents of high risk infants can present posttraumatic stress reactions such as intrusion, avoidance or arousal symptoms. The French version of the "Perinatal PTSD Questionnaire" has satisfactory psychometric properties. Conclusions: As posttraumatic reactions are not directly related to objective descriptions of the stressful event, it may be essential to the liaison child psychiatrist to consider individual posttraumatic reactions in order to optimise preventive intervention with the parents. A questionnaire should not replace a clinical interview, however it may represent a useful screening tool. Also, this questionnaire should be useful for research purposes. (PsycINFO Database Record (c) 2005 APA, all rights reserved)

Blood pressure target attainment in the background of guidelines: the very elderly in Swiss primary care.

Background There are only a few trials for the very elderly population (>79 years). No consensus, which blood pressure (BP) goals and substances should be applied, has been found yet. This survey was undertaken to investigate how octogenarians are treated and attain BP targets in the Swiss primary care. Methods Data from 4594 hypertensive patients were collected within 7 days. Eight hundred and seventy-seven patients met the requirement to be >79 years. We assessed substances/combinations and investigated pulse pressure and target blood pressure attainment (TBPA) using three different recommendations [Canadian Hypertension Education Program (CHEP), Swiss Society of Hypertension (SSH), European Society of Hypertension-European Society of Cardiology (ESH-ESC)]. Secondarily, we compared TBPA attained by angiotensin-converting enzyme inhibitor (ACEI)/diuretic (D), angiotensin receptor blocker (ARB)/D and calcium channel blocker (CCB)/D with any other dual therapy and investigated whether Ds/beta-blockers (BBs) or Ds/renin angiotensin-converting enzyme inhibitors (RAAS-Is) lead to higher TBPA. Finally, we assessed the impact of drug administration, practical work experience, location and specialization of GPs on TBPA. Results Octogenarians attained target blood pressure (TBP) between 44% (ESH-ESC) and 74% (SSH). Optimal/normal BP was reached in 22.8% of patients. Pulse pressure <65 mmHg was shown in 66.4% of patients. Monotherapy was most commonly applied followed by dual single-pill combination with ARB/D (46.5%) or ACEI/D (36.0%). No benefit in TBPA was found comparing a RAASI/D and CCB/D treatment with any other dual combination. There was also no difference between BB/D and RAAS-I/D combination therapy and between single-pill combination and dual free combinations. Conclusions GPs adhere to the use of substances proven in outcome trials and attain high TBP. No difference in meeting BP goals could be found using different drug classes. There is an unmet need to harmonize recommendations and to add additional information for the treatment of octogenarians.

Nine-month-olds' triangular interactive strategies with their parents' couple in low-coordination families: A descriptive study

Observing infants in triadic situations has revealed their triangular competence; namely, their ability to interact with both parents by simultaneously sharing their attention and affects with them. Infants' triangular interaction is linked with the coparenting unit's degree of coordination; in high-coordination (HC) families, parents act as a team in relation to the child, thus drawing clear and flexible boundaries with them; in low-coordination (LC) families, parents either avoid direct interaction with each other and include the child in their unit or join together against the child and exclude him or her, thus drawing inconsistent boundaries with the child. We explored the interactive strategies of LC 9-month-olds (n = 15) with those of their parents, comparing them with HC parents (n = 23) in two conditions: playing with both parents at the same time and witnessing their parents' dialogue. LC infants' affects were less positive; they addressed fewer positive triangular bids to their parents and tended to use a less triangular interactive mode. Thus, LC infants had fewer opportunities than did HC infants to acquire skills necessary for coping with triangular interaction. L'observation de nourrissons dans des situations triadiques a révélé leur compétence triangulaire, c'est-à-dire la capacité à interagir avec les deux parents en partageant simultanément leur attention et leurs affects avec eux. L'interaction triangulaire des nourrissons est liée au degré de coordination de l'unité de coparentage. Dans les familles à coordination élevée (abrégé HC en anglais, CE en français), les parents agissent en relation à l'enfant en tant qu'équipe, et établissent donc des limites claires et flexibles avec les enfants. Dans les familles à coordination faible (abrégé LC en anglais, CF en français), les parents évitent soit l'interaction directe l'un avec l'autre et incluent l'enfant dans leur unité, ou bien ils se liguent contre l'enfant et l'excluent, établissant donc des limites contradictoires avec l'enfant. Nous explorons les stratégies interactives de bébés de 9 mois CF avec celle de leurs parents, en les comparant avec des parents CE (N = 23) dans deux conditions: le jeu avec les deux parents au même moment et l'observation du dialogue des parents. Les affects des bébés CF étaient moins positifs. Les bébés se tournaient moins triangulairement vers leurs parents et avaient tendance à utiliser un mode interactif moins triangulaire. Les bébés CF avaient donc moins de chances que les bébés CE d'acquérir les compétences nécessaires pour faire face avec une interaction triangulaire.

Epidemiology of incident heart failure in a contemporary elderly cohort: the health, aging, and body composition study.

BACKGROUND: The race- and sex-specific epidemiology of incident heart failure (HF) among a contemporary elderly cohort are not well described. METHODS: We studied 2934 participants without HF enrolled in the Health, Aging, and Body Composition Study (mean [SD] age, 73.6 [2.9] years; 47.9% men; 58.6% white; and 41.4% black) and assessed the incidence of HF, population-attributable risk (PAR) of independent risk factors for HF, and outcomes of incident HF. RESULTS: During a median follow-up of 7.1 years, 258 participants (8.8%) developed HF (13.6 cases per 1000 person-years; 95% confidence interval, 12.1-15.4). Men and black participants were more likely to develop HF. No significant sex-based differences were observed in risk factors. Coronary heart disease (PAR, 23.9% for white participants and 29.5% for black participants) and uncontrolled blood pressure (PAR, 21.3% for white participants and 30.1% for black participants) carried the highest PAR in both races. Among black participants, 6 of 8 risk factors assessed (smoking, increased heart rate, coronary heart disease, left ventricular hypertrophy, uncontrolled blood pressure, and reduced glomerular filtration rate) had more than 5% higher PAR compared with that among white participants, leading to a higher overall proportion of HF attributable to modifiable risk factors in black participants vs white participants (67.8% vs 48.9%). Participants who developed HF had higher annual mortality (18.0% vs 2.7%). No racial difference in survival after HF was noted; however, rehospitalization rates were higher among black participants (62.1 vs 30.3 hospitalizations per 100 person-years, P < .001). CONCLUSIONS: Incident HF is common in older persons; a large proportion of HF risk is attributed to modifiable risk factors. Racial differences in risk factors for HF and in hospitalization rates after HF need to be considered in prevention and treatment efforts.